Pick any industry today and you’re likely to hear managers complain about talent shortages and hiring woes. For home health agencies, the problem is at an all-time high. CNBC reported earlier this year that employment for home aides is expected to grow 41% from 2016 to 2026, which equates to 7.8 million job openings. And that means fierce competition for talent.
According to Home Health Care News, the industry turnover sits somewhere between 40-67%, with the cost to onboard a new caregiver in the range of $2,600. That’s an expensive proposition for home health agencies that have little choice than to fight the fight since they’re only as good as the staff they employ.
Therapy providers step in
As a contract therapy provider, you have an opportunity to significantly ease these staffing pressures with a large pool of experienced therapists, and a deep understanding of how to manage therapy resources while keeping costs down. However, you also have to keep in mind that therapy staffing within home health comes with its own unique set of challenges.
Getting the therapist ratio right
Therapy assistants are paid less than therapists, but many home health agency contracts are set up to bill the agency by the visit, which means you’re getting paid the same rate, regardless of who’s providing the therapy. It’s likely that the by-visit approach will continue under the Patient-Driven Groupings Model (PDGM), so this will be a key area to watch out for. You’ll need to carefully establish the appropriate assistant/therapist ratio from the start in order to maximize revenue, while ensuring patient outcomes. And while you may opt to have your assistants deliver the bulk of therapy and save your therapists for the evaluations, plan of care and ongoing supervision, there is no one-size-fits-all approach.
Above all else, you’ll need to keep in mind the specific therapy needs of the individual patient, the team members best qualified to provide that service, and the appropriate state and federal regulations. This will be especially important under PDGM, where payment will be based on the individual patient’s condition and resources needs, rather than volume of therapy visits.
Regulatory change afoot
Each state has its own regulations as far as the number of therapists to therapy assistants, and when an assistant can be used vs. a therapist. Adding to the confusion is the fact that what’s acceptable in other care settings may not be acceptable in home health. As outlined in the proposed 2020 home health payment update, Medicare allows for skilled maintenance therapy in a SNF, home health and other outpatient settings. But the type of clinician who can provide those services varies. In some settings, both the therapist and assistant can deliver maintenance therapy, but in others only the therapist can. For instance, Medicare allows therapy assistants to provide maintenance therapy in a SNF, but not in a home health setting.
This may soon change, as CMS has proposed allowing therapy assistants to performance maintenance services established by a qualified therapist under the home health benefit, as long as it is allowed under the state licensure laws.
In a tough staffing environment, this would provide greater latitude in managing therapy resources. Also, if the proposed rule is finalized, it would align with how assistants are used in other care settings. So, if you serve SNFs, you’d be able to leverage your assistants already providing maintenance therapy in these facilities to your home health clients.
To help manage this complexity, look for therapy software that guides your team to match the right therapist/assistant and discipline with the right patient, and keeps the visits on track with physicians’ orders through alerts and guardrails.
Another area to consider is scheduling efficiency. As mentioned in an earlier blog post, providing therapy to homebound patients requires greater coordination with the agency to ensure timely care. If you aren’t completely in lockstep with what the agency is doing—or vice versa—then scheduling can become a management nightmare and affect your relationship with the agency.
For instance, if the agency has no visibility into the therapy schedule, your therapist may show up at a home only to find that the nurse is already there treating the patient. That’s wasted driving time for the therapist and additional unbillable time on the clock—not to mention it prolongs patient care.
At a minimum, the therapy software you use should give the agency total visibility over therapists’ schedules and provide the ability to add appointments based on their own nursing schedule. Better yet, find out whether the software gives you the visibility to manage your therapists’ time across all the care settings you serve. Your team needs the ability to identify who’s available and when, schedule visits and communicate any changes to the agency via secure messaging and other real-time notifications.
As you look to establish or grow your home health therapy business, it will be important to consider all the factors that impact staffing requirements and then plan accordingly. To find out how Optima Therapy for Home Health can help you manage your staffing and drive outcomes, request a demo.